Anatomy Flashcards
What are the superficial veins of the upper limb?
Cephalic vein
Basilic vein
Median Cubital vein
Dorsal venous network
Where does the cephalic vein run?
Between the deltoid and pectoralis major
Where does the basilic vein run?
Parallel but medially to the cephalic vein
Where does the medial cubital vein run?
Between the cephalic and basilic veins at around the level of the elbow
Infective cells are picked up by lymph in the superficial vessels of the hand. How is this transported proximally?
Lymphatic vessels can run with both the cephalic and basilic veins.
The lymph follows the cephalic vein, where does it drain to next?
Apical axillary nodes
The lymph follows the basilic vein, where does it now drain to?
Cubital nodes (anterior to the medial epicondyle) From there is drains to humeral (lateral) axillary nodes
If the infective cells were picked up by deep lymphatic vessels, where would the lymph drain to?
Humeral (lateral) axiallary nodes
What is the final stage for the lymph once it has drained to the axillary nodes?
Follows subclavian vein to either the right lymphatic duct or (left) thoracic duct and then to the venous angle.
Where is peripheral venous access commonly achieved in the upper limb?
Dorsal venous network of hand
“Houseman’s vein” (cephalic vein on lateral aspect of distal forearm)
Median cubital vein in the cubital fossa.
What is the axilla?
The pyrimidal space inferior to the glenohumeral joint and superior to the axillary fascia at the junction of the arm and throax.
What muscles make up the anterior wall of the axilla?
Pectoralis major and minor
What muscle makes up the medial wall of the axilla?
Serratus anterior
What muscles make up the posterior wall of the axilla?
Latissimus dorsi
Teres major
Subscapularis
What vessels and nerves run within the axillary sheath?
Axillary vein
Axillary artery
Brachial plexus
Other than the nerves of the brachial plexus, what other major nerve runs within the axilla?
Long thoracic nerve
What groups of lymph nodes are in the axilla?
Humeral Pectoral Subscapular Central Apical
What are the different parts of the brachial plexus? (Proximal to distal)
Roots Trunks Divisions Cords Terminal branches
What are the roots of the roots of the brachial plexus?
C5-T1 branches from spinal cord
What are the trunks of the brachial plexus?
Superior (C5+C6)
Middle (C7)
Inferior (C8+T1)
What are the divisions of the brachial plexus?
Each of the branches have posterior and anterior divisions
What are the Cords of the brachial plexus?
Lateral (Anterior divisions of superior and middle trunks)
Posterior (Posterior divisions of superior, middle and inferior trunks)
Medial (Anterior division of the inferior trunk)
What are the terminal branches of the brachial plexus?
Musculocutaneous (from lateral cord) Axillary (from posterior cord) Radial (from posterior cord) Median (From lateral and medial cords) Ulnar (from median cord)
Where is the brachial plexus in relation to the subclavian vein?
Immediately posterior
What does the musculocutaneous nerve supply?
Coracobrachialis
All muscles in the anterior compartment of the arm
Where does the axillary nerve go?
Into the posterior compartment of the arm, superior to the radial nerve, around the posterior aspect of the surgical neck of the humerus
Where does the radial nerve go?
Into the posterior arm compartment, around the posterior aspect of the mid-shaft of the humerus
Where does the ulnar nerve go?
Posteriorly into the medial aspect of the arm - most medial brachial plexus nerve
How can the median nerve be located?
Is the middle of the “M-shape” configuration of the axillary named nerves
Which nerve is most at risk of injury with a mid-shaft humeral fracture?
Radial
Which nerve is most at risk of injury with a shoulder dislocation?
Axillary
What is the pectoral girdle?
Set of bones that connects the upper limbs to the axial skeleton
What bones make up the pectoral girdle?
Scaula
Clavicle
Manubrium of sternum
How many joints does the pectoral girdle have?
5 (3 true and 2 false)
What are the true joints of the pectoral girdle?
Glenohumeral (head of humerus and glenoid cavity of scapula)
Acromioclavicular (acromion process of scapula and lateral end of clavicle)
Sternoclavicular (manubrium of sternum and the 1st costal cartilage with the medial end of the scapula)
What are the false joints of the pectoral girdle?
Scapulocostal (anterior scapula and posterior thoracic ribcage via muscles and ligaments)
Suprahumeral (coracoacromial ligament and the head of the humerus)
For full range of movement from the pectoral girdle, what must occur?
Simultaneous movement of all true joints
Mobility of scapula
Superior rotation of glenoid
What movements does the deltoid muscle permit?
Posterior part - allows shoulder extension and lateral rotation
Acromial part - abducts the arm
Clavicular part - flexes and medially rotates the arm
What are the attachments of the deltoid muscles?
Proximally to: lateral thrid of clavicle, acromion, and spine of scapula
Ditally to deltoid tuberosity of humerus
What nerve innervates the deltoid muscles
Axillary (C5 + C6)
What muscles make up the rotator cuff muscles (SITS)
Supraspinatus
Infraspinatus
Teres Minor (+ Major)
Subscapularis
What movements does the supraspinatus aid with?
Abduction of arm
Rotation of arm (with other rotator cuff muscles)
Where does the supraspinatus attach to?
Proximally - supraspinatus fossa od scapula
Distally - superior facet of the greater tubercle of the humerus
What nerve innervates the supraspinatus?
Suprascapular nerve (C5, C4 + C6)
What movements does the infraspinatus produce?
Internal rotation of arm
Acts with other rotator cuff muscles
Where does the infraspinatus attach to?
Proximally - infraspinatus fossa of scapula
Distally - middle facet of greater tubercle
What nerve innervates the infraspinatus?
Suprascapular nerve (C5 + C6)
What movements does the Teres Minor produce?
Laterally rotates the arm
Acts with other rotator cuff muscles
Where does Teres Minor attach to?
Proximally - middle part of the lateral border of the scapula
Distally - Inferior facet of the greater tubercle
What nerve innervates the Teres Minor?
Axillary (C5 + C6)
What movements does the Teres Major produce?
Adduction and medial rotation of the arm
Where does the Teres Major attach to?
Proximally - Posterior surface of the interior angle of the scapula
Distally - Middle lip of inter-tubercular sulcus of humerus
What nerve innervates the Teres Major?
Lower subscapular nerve (C6 + C5)
What movements does the subscapularis produce?
Medial rotation of arm
Holds humeral head in the glenoid cavity
Acts with other rotator cuff muscles
Where does the subscapularis attach to?
Proximally - Subscapular fossa
Distally - Lesser tubercle of humerus
What nerve innervates the Subscapularis?
Upper and lower subscapular nerves (C6, C5 + C7)
What is the rotator cuff?
Musculotendinous cuff around the glenohumeral joint
What movements does the Trapezius produce?
Descending part - elevates scapula
Ascending part - depresses scapula
Middle part - retrats scapula
Descending + Ascending = superior rotation of the glenoid cavity
Where does the trapezius attach to?
Proximally - medial third of superior nuchal line, external occipital proturbance, nuchal ligament, spinous processes of C7-T12 vertebrae
Distally - Lateral third of clavicle, acromion, spine of scapula
What nerve(s) is the trapezius innervated by?
Spinal Accessory Nerve (CN XI) (motor fibres)
C3, C4 spinal nerves (pain and proprioceptive fibres)
What movements does the latissimus dorsi produce?
Extension, adduction and medial rotation of humerus
Raises body towards arms during climbing
Where does the latissimus dorsi attach to?
Proximally - Spinous processes of inferior 6 thoracic vertebrae, thoracolumnar fascia, iliac crest and interior 3/4 ribs
Distally - floor of intertubercular sulcus of humerus
What nerve supplies the latissimus dorsi?
Thoracodorsal (C6, C7 + C8)
What movements does the levator scapulae produce?
Elevation of scapula
Rotates the glenoid cavity
Where does the levator scapulae attach to?
Proximally - Posterior tubercles of transverse processes of C1-C4 vertebrae
Distallt - medial border of scapula, superior to the root of the scapular spine
What nerves innervate the levator scapulae?
Dorsal scapular (C4 + C5) Cervical (C3 + C4)
What movements doe the rhomboid minor and major produce?
Retract scapula
Rotate glenoid cavity inferiorly
Fixes scapula to thoracic wall
What does the Rhomboid Minor attach to?
Proximally - nuchal ligament, spinous processes of C7 + T1
Distally - Smooth triangular area at the medial end of the scapular spine
What does the Rhomboid Major attach to?
Proximally - spinous processes of T2-T5
Distally - Medial border of scapula from level of spine to inferior angle
What nerve innervates both the Rhomboid Major and Minor?
Dorsal scapular nerve (C5 + C4)
What are the 4 posterior axio-appendicular muscles?
Trapezius
Latissimus dorsi
Levator scapulae
Rhomboid major and minor
What are the 4 anterior axio-appendicular muscles?
Pectoralis major
Pectoralis minor
Sub-clavius
Serratus anterior
What movements does the pectoralis major produce?
Adducts + Medially rotates humerus
Moves scapula anteriorly + inferiorly
Clavicular head - flexes humerus
Sternocostal head - extends humerus
Where does the clavicular head of the pectoralis major attach to?
Proximally - Anterior surface of medial half of clavicle
Distally - Lateral lip of intertubercular sulcus of humerus
Where does the sternocostal head of the pectoralis major attach to?
Proximally - Anterior surface of sternum, superior 6 costal cartilages, the aponeurosis of the external oblique muscle
Distally - Lateral lip of intertubercular sulcus of humerus
What nerve innervates the pectoralis major?
Lateral and medial pectoral Clavicular head (C6 + C5) Sternocostal head (C7, C8 + T1)
What movements does the pectoralis minor produce?
Stabilises scapula by drawing it inferiorly and anteriorly
Where does the pectoralis minor attach to?
Proximally - 3rd-5th ribs near their costal cartilage
Distally - Medial border and superior surface of coracoid process of scapula
What nerve innervates the pectoralis minor?
Medial pectoral (C8 + T1)
What movements does the sub-clavius muscle produce?
Anchors and depresses clavicle
What does the sub-clavius attach to?
Proximally - Junction of 1st rib and costal cartilage
Distally - inferior surface of middle third of clavicle
What nerve innervates the sub-clavius?
Nerve to subclavius (C5 + C6)
What movements does the serratus anterior produce?
Protracts scapula
Rotates scapula
Where does the serratus anterior attach?
Proximally - external surfaces of lateral parts of 1st-8th ribs
Distally - Anterior surface of medial border of scpula
Which nerve innervates the serratus anterior?
Long thoracic nerve (C6, C5 + C7)
What articulation makes up the glenohumeral joint?
Humeral head and glenoid cavity of scapula
What is the function of the glenoid labrum?
Deepens the otherwise very shallow gelnoid cavity
What is the role of the glenohumeral ligaments?
Stregthen anterior aspect of the joint capsule
What is the Coracohumeral ligament?
Strong, broad band connecting the base of the coracoid process to the anterior aspect of the greater tubercle of the humerus
What is the transverse humeral ligament?
Broad fibrous band running obliquely from the greater to lesser tubercles of the humerus
Where is the coraco-acromial ligament found?
Spanning the acromion and the coracoid process of the scapula
What does the coraco-clavicular joint do?
Connects the coracoid process of the scapula to the clavicle in 2 places:
Trapezoid part - more distally and anteriorly
Conoid part - more proximally and posteriorly
Where is the subtendionous bursa of the subscapularis found?
Between the tendon of the subscapularis and the neck of the scapula
Where is the subacromial bursa found?
Between the acromion, coraco-acromial ligaments and the deltoid superiorly; and the joint capsule of the glenohumeral joint and the supraspinatus tendon inferiorly
How would you test the motor function of the axillary nerve?
Deltoid and Teres Minor
Palpate at the shoulder while patient undergoes resisted shoulder abduction
How would you test the sensory function of the axillary nerve?
Test sensations over the lateral cutaneous aspect of the shoulder
What are the articular surfaces of the elbow joint?
Spool-shaped trochlea + spheroidal captulum of the humerus; articulate with the trochlear notch of the ulna + the superior aspect of the radial head.
What are collateral ligaments?
Strong triangular bands which are medial and lateral thickenings of the fibrous layer of the joint capsule
Where does the radial collateral ligament extend?
Lateral epicondyle of humerus and then blends with the anular ligament of the radius
What does the anular ligament of the radius do?
Encircles and holds the radial head in the radial notch of the ulna
What movement does the anular ligament allow?
Pronation and supination of the forearm
Where does the ulnar collateral ligament extend?
Medial epicondyle of the humerus - coronoid process and olecranon of the ulna
The ulnar collateral ligament contains a number of different bands, what are these called, and what do they do?
Anterior - strongest, cord-like
Posterior - weakest, fan-like
Oblique - deepens socket for humeral trochlea
What surrounds all of the compartments of the arm?
Brachial fascia
What muscle(s) lie in the posterior arm compartment?
Triceps brachii
The triceps brachii has 3 heads, what are each of these, and where do they attach proximally to?
Long head - Infraglenoid tubercle of scapula
Lateral head - Posterior surface of humerus, superior to the radial groove
Medial head - Posterior surface of the humerus, inferior to the radial groove
Where do all of the triceps brachii heads attach to?
Proximal end of ulnar olecranon and the forearm fascia
What movements does the triceps brachii produce?
Extension of forearm
Long head - resists shoulder dislocation
Which nerve innervates the triceps brachii?
Radial nerve (C7, C8 + C6)
What is the role of the radial nerve and the profunda brachii artery?
Supply all of the muscles in the posterior arm and forearm compartments
Where does the radial nerve and profunda brachii artery go?
Enters arm posterior to brachial artery, medial to the humerus and anterior to the long head of triceps
Descends inferolaterally and passes around the humeral shaft in the radial groove
At the lateral humeral border it pierces the lateral intermuscular septum = continues to anterior compartment between the brachialis and the brachioradialis to the level of the lateral humeral epicondyle
What are the articulating surfaces of the proximal radio-ulnar joint?
Radial head with the radial notch of the ulna
What are the articulating surfaces of the distal radio-ulnar joint?
Rounded head of ulna with the ulnar notch on the medial side of the distal radius.
What ligaments support the proximal radio-ulnar joint?
Strong anular ligament - encircles the radial head (attaches anteriorly to the ulna and posteriorly to the radial notch)
What ligaments support the distal radio-ulnar joint?
Anterior and posterior ligaments support the fibrous joint capsule.
Transverse bands extend from radius to ulna both anteriorly and posteriorly
What surrounds the compartments of the forearm?
Antebrachial fascia
What separates the compartments of the forearm?
Interosseous membrane
In general what function do the muscles of the posterior forearm compartment have?
Extension
Supination
What muscles make up the superficial layer of muscles in the posterior compartment of the forearm?
Brachioradialis Extensor carpiradialis longis (ECRL) Extensor carpi radialis brevis (ECRB) Extensor digitorum Extensor digiti minimi (EDM) Extensor carpi ulnaris (ECU)
What movements does the brachioradialis produce?
Weak flexion of forearm - maximal when forearm is mid-pronated
Where does the brachioradialis attach to?
Proximally - proximal 2 thurds of supra-epicondylar ridge of humerus
Distally - lateral surface of the distal radius, proximal to the styloid process
Which nerve innervates the brachioradialis?
Radial (C6, C5 + C7)
What movements does the ECRL produce?
Extension and abduction of the hand at the wrist joint
Where does the ECRL attach to?
Proximally - lateral supra-epicondylar humeral ridge
Distally - Dorsal aspect of the 2nd metacarpal base
Which nerve innervates the ECRL?
Radial (C6 + C7)
What movements does the ECRB produce?
Extension and abduction of the hand at the wrist joint
Where does the ECRB attach to?
Proximally - lateral supra-epicondylar humeral ridge
Distally - Dorsal aspect of the 3rd metacarpal base
Which nerve innervates the ECRB?
Deep branch of radial (C7 + C8)
What movements does the extensor digitorum produce?
Extension of medial 4 digits
Where does the extensor digitorum attach to?
Proximally - lateral epicondyle of humerus
Distally - Extensor expansions of the medial 4 digits
Which nerve innervates the extensor digitorum?
Deep branch of radial (C7 + C8)
What movements does the EDM produce?
Extension of 5th digit
Where does the EDM attach to?
Proximally - lateral epicondyle of humerus
Distally - Extensor expansion of 5th digit
What nerve innervates the EDM?
Deep branch of radial (C7 + C8)
What movements does the ECU produce?
Extension and adduction of the hand at the wrist joint
Where does the ECU attach to?
Proximally - lateral epicondyle of humerus + posterior border of ulna (shared aponeurosis)
Distally - dorsal aspect of the 5th metacarpal base
What nerve innervates the ECU?
Deep branch of radial (C7 + C8)
What muscles make up the deep layer of the posterior compartment of the forearm?
Supinator
Extensor indicis
What movements does the supinator produce?
Supination of the forearm
Where does the supinator attach to?
Proximally - Lateral epicondyle of humerus + radial collateral ligament + anular ligaments + supreior fossa + crest of the ulna
Distally - Lateral, posterior and anterior surfaces of the proximal 3rd of the radius.
Which nerve innervates the supinator?
Deep branch of radial (C8 + C7)
What movements does the extensor indicis produce?
Extension of the 2nd digit
Extension of the hand at the wrist
Where does the extensor indicis attach to?
Proximally - posterior surface of distal third of ulna
Distally - Extensor expansion of 2nd digit
Which nerve innervates the extensor indicis?
Posterior interosseous nerve (C7 + C8)
What are the outcropping muscles of the deep layer of the posterior forearm compartment?
Abductor pollicis longus (APL)
Extensor pollicis longues (EPL)
Extensor pollicis brevis (EPB)
What movements does the APL produce?
Abduction of teh thumb
Extension of thumb
Where does the APl attach?
Proximally - Posterior surface of proximal half of the ulna,radius, and interosseous membrane.
Distally - base of 1st metacapral
Which nerve innervates the APL?
Posterior interosseous nerve (C8 + C7)
What movements does the EPL produce?
Extension of distal phalynx of thumb
Where does the EPL attach to?
proximally - posterior surface of the middle third of the ulna + interosseous membrane
Distally - dorsal aspect of the base of the distal thumb phalynx
What nerve innervates the EPL?
Posterior interosseous nerve (C8 + C7)
What movements does the EPB produce?
Extension of the proximal phalnx of the thumb
Where does the EPB attach?
Proximally - posterior surface of distal third of the radius + interosseous membrane
Distally - Dorsal aspect of proximal thumb phalynx base
What nerve innervates the EPB?
Posterior interosseous nerve (C8 + C7)
The interosseous nerve is the deep branch of the radial nerve: but where does it run?
Between the 2 muscle layers of the posterior forearm compartment
What artery supplies the posterior forearm compartment?
Posterior interosseous artery (runs with deep branch of radial nerve)
